Who is part of the team?
The team includes four linguists (Elena Semino, Veronika Koller, Andrew Hardie and Zsófia Demjén), a computer scientist (Paul Rayson), and the Director of Lancaster University’s International Observatory on End of Life Care, Sheila Payne.
What is the study about?
We are studying the language used by members of three groups of people that can be described as stakeholders in end of life care: patients, unpaid family carers and senior healthcare professionals.
We have collected a large body of data (1.5 million words) consisting of interviews with members of each group (approximately 100,000 words per group) and contributions to online fora by members of each group (approximately 400,000 words per group). The specific aspect of language we focus on is metaphor.
Metaphor involves talking and thinking about one thing in terms of another. When we say that someone died after a ‘battle’ with cancer, we talk about being ill and attempting to get better in terms of military conflict. When we say that someone has ‘passed away’, we talk about dying in terms of moving away from where we are.
Metaphors are frequently used to talk about subjective, complex and sensitive experiences, such as, for example, the emotions around death. The metaphors we choose both reflect and affect how we ‘see’ what we are talking about. The ‘battle’ metaphor for illness, for example, highlights the way in which being ill may involve strength, perseverance, endurance and heroism, and encourages us to understand recovering health as a victory and not recovering or dying as a defeat.
On the other hand, this metaphor backgrounds other ways of thinking about illness, such as, for example, the way in which one may accept and live with an illness. In addition, it risks making patients feel as though their body is a battlefield on which a war is being fought.
However, the shortcomings of a particular metaphor may be overcome by replacing it, or using it alongside an alternative metaphor. For example, seeing the experience of illness as a journey can highlight both progress and lack of progress, obstacles or difficulties one may encounter, as well as routine, companionship, and so on.
Different metaphors may be more or less appropriate for different people, or for the same person at different times.
What methods does the project involve?
We employ both ‘manual’ analysis based on well-established linguistic techniques and computational analysis to identify and analyse metaphor in our data. The most innovative aspect of our method is the use of a software tool that was developed by a member of our team for linguistic analysis, Wmatrix.
Wmatrix includes a module that can group individual words into categories of meaning. For example, expressions such as ‘journey’, ‘going’, ‘slipping’ and ‘reaching’ would all be grouped under ‘Movement’. We can explore categories of meaning that are likely to be used metaphorically in context and identify examples in the entire data set without having to search for every possible word individually. This allows us to identify metaphorical expressions more systematically than is currently possible, not only manually, but also with the help of other semi-automated tools.
What have you found so far?
We are still in the early days of the project. However, in our interviews with hospice managers, we have noticed that the contrast between ‘good’ and ‘bad’ deaths is partly expressed via contrasting metaphors. These include, for example, the contrast between death as the accepted end of a ‘journey’ and death as an opponent against which to ‘struggle’, ‘battle’ or ‘fight’ in order to ‘keep going’.
The aim of end of life care is described as being the facilitation of a good death, often through the ‘control’ and ‘resolving’ of any ‘struggles’. Similarly, a good death is described as involving many ‘open’ conversations, while a bad death is described as involving problems ‘in the background’ or in a ‘place’ inside the patient that hospice staff are not allowed to ‘reach’.
What are you hoping to achieve?
By analysing systematically the metaphors used by different stakeholder groups to talk about end of life care, we will gain a better understanding of their views, experiences and needs.
Any differences and similarities in the use of metaphor within and across each group will help us draw conclusions about potential opportunities and difficulties in relationships among patients, carers and professionals.
Our findings will have implications for practice and training in the provision of end of life care.
We are already working with a local group in Lancaster who can give us the perspective of patients and their families. We are very keen to share our work and findings with groups and organisations involved with end of life care, in the hope of making a positive impact on the experience of patients approaching the end of life.